Bell’s Palsy

Notes

Definition
  • Bell’s palsy (facial paralysis) is due to peripheral involvement of the seventh cranial nerve on one side, which results in weakness or paralysis of the facial muscles.
  • The cause is unknown, but possible causes may include vascular ischemia, viral disease (herpes simplex, herpes zoster), autoimmune disease, or a combination.
  • Bell’s palsy may represent a type of pressure paralysis in which ischemic necrosis of the facial nerve causes a distortion of the face, increased lacrimation (tearing), and painful sensations in the face, behind the ear, and in the eye.
  • The patient may experience speech difficulties and may be unable to eat on the affected side owing to weakness.
  • Most patients recover completely, and Bell’s palsy rarely recurs.

 

Medical Management
  • The objectives of management are to maintain facial muscle tone and to prevent or minimize denervation.
  • Corticosteroid therapy (prednisone) may be initiated to reduce inflammation and edema, which reduces vascular compression and permits restoration of blood circulation to the nerve.
  • Early administration of corticosteroids appears to diminish severity, relieve pain, and minimize denervation.
  • Facial pain is controlled with analgesic agents or heat applied to the involved side of the face.
  • Additional modalities may include electrical stimulation applied to the face to prevent muscle atrophy, or surgical exploration of the facial nerve.
  • Surgery may be performed if a tumor is suspected, for surgical decompression of the facial nerve, and for surgical rehabilitation of a paralyzed face.
Nursing Management

Patients need reassurance that a stroke has not occurred and that spontaneous recovery occurs within 3 to 5 weeks in most patients. Teaching patients with Bell’s palsy to care for themselves at home is an important nursing priority.

Teaching Eye Care

Because the eye usually does not close completely, the blink reflex is diminished, so the eye is vulnerable to injury from dust and foreign particles. Corneal irritation and ulceration may occur. Distortion of the lower lid alters the proper drainage of tears. Key teaching points include the following:

  • Cover the eye with a protective shield at night.
  • Apply eye ointment to keep eyelids closed during sleep.
  • Close the paralyzed eyelid manually before going to sleep.
  • Wear wraparound sunglasses or goggles to decrease normal evaporation from the eye.
Teaching About Maintaining Muscle Tone
  • Show patient how to perform facial massage with gentle
  • upward motion several times daily when the patient can tolerate the massage.
  • Demonstrate facial exercises, such as wrinkling the forehead,
  • blowing out the cheeks, and whistling, in an effort to prevent muscle atrophy.
  • Instruct patient to avoid exposing the face to cold and drafts

Exam

Welcome to your MSN Exam for Bell’s Palsy! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 10 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Focus on the disease that primarily affects cognitive function and is not commonly associated with conditions affecting the cranial nerves or facial muscles.

1 / 10

1. Nurse Williams is conducting a seminar on Bell's palsy and its associated risk factors. During the session, she decides to address misconceptions and clarify which conditions have not been directly linked to Bell's palsy. Which disease should Nurse Williams mention as not having a direct link with Bell's palsy?

💡 Hint

Identify the cranial nerve known primarily for its role in facial expressions and movement.

2 / 10

2. Bell's palsy is a condition that specifically involves a disturbance in a certain cranial nerve, leading to symptoms affecting facial movement and expressions. Which cranial nerve is affected by Bell's palsy?

💡 Hint

Consider the neurological connection between the cranial nerves and pupil response to light.

3 / 10

3. During a routine check-up, Nurse Miller notices that Ms. Jones has dilated pupils that do not constrict when exposed to light. Understanding the significance of this finding, Nurse Miller begins to consider what this symptom might indicate regarding Ms. Jones's condition. What should Nurse Miller associate this symptom with?

💡 Hint

Focus on the cranial nerve that is primarily responsible for facial movement and expressions.

4 / 10

4. Nurse Peterson is reviewing the case of a patient recently diagnosed with Bell's palsy. As part of her preparation for patient education, she recalls the specific cranial nerve that is affected by this condition. Which cranial nerve is involved in Bell's palsy, as Nurse Peterson should remember?

💡 Hint

Consider which activity could potentially worsen the condition rather than aid in preserving muscle tone and nerve function.

5 / 10

5. Nurse Carter is providing guidance to a male patient diagnosed with Bell's palsy on how to maintain facial muscle tone and prevent nerve degeneration. After sharing various strategies, she evaluates the patient's understanding. Which statement made by the patient indicates a need for further instruction from Nurse Carter?

💡 Hint

Reflect on the specific area of the body affected by Bell's palsy and whether it is known to directly impact limb strength or language abilities.

6 / 10

6. Nurse Evans is providing information about Bell's palsy to a patient. The patient is concerned about the potential symptoms and asks whether the condition can be associated with arm and leg weakness and difficulty finding the right words. Is this statement accurate regarding Bell's palsy?

💡 Hint

Consider the effects of facial paralysis on eyelid function and the subsequent potential risk to the eye's surface.

7 / 10

7. Nurse Taylor is discussing complications of Bell's palsy with a patient who has recently been diagnosed with the condition. She explains the potential issues that can arise due to the nature of the condition, particularly concerning the eyes. Is it true that an inability to properly close the eye can occur in Bell's palsy, potentially leading to corneal damage?

💡 Hint

Recall the specific cranial nerve known for controlling facial movement and expressions, which is implicated in Bell's palsy.

8 / 10

8. Nurse Grant is reviewing the anatomy and physiology related to Bell's palsy with a group of nursing students. She emphasizes the importance of understanding the specific cranial nerve involved in this condition. Is it accurate to say that Bell's palsy is caused by a dysfunction of the 8th cranial nerve?

💡 Hint

Focus on the answer that lists a combination of possible contributing factors, including one related to blood flow and another to infectious or immune conditions, rather than specific genetic or toxin-related causes.

9 / 10

9. Nurse Thompson is caring for Mr. Jackson, who has recently been diagnosed with Bell's palsy. Mr. Jackson is curious and concerned about what might have led to his condition. Nurse Thompson prepares to explain to Mr. Jackson, based on her knowledge, the potential factors that might have caused Bell's palsy. What should she include in her explanation?

💡 Hint

Consider the role of this type of medication in reducing inflammation and swelling, which might be beneficial in certain nerve-related conditions.

10 / 10

10. Nurse Benson is discussing treatment options for Bell's palsy with a colleague. They touch upon the effectiveness of certain medications in reducing the symptoms of this condition. Nurse Benson acknowledges that one type of medication might be beneficial. Is it true that oral steroids can help reduce the symptoms of Bell's palsy?

Nursing Care Plan

Nursing Diagnosis

Body image disturbance related to alteration in structure and function for vision secondary to Bell’s Palsy.

Desired Outcomes:

Within 1 hour of nursing interventions, the patient will be able to demonstrate increased self esteem and body image by the ability to acknowledge, touch, and look at altered body part.

Nursing Interventions
  • Assess patients knowledge of change in structure or function of the body part.
    • Rationale: The level of response is related to the perceived value or importance that the patient places on the affected body part.
  • Assist patient to identify actual changes
    • Rationale: Patients may perceive changes that are not actually present.
  • Encourage verbalization about concerns of the disease process and future expectations.
    • Rationale: This provides an opportunity to identify fears/misconceptions and deal with them directly.

Nursing Diagnosis

Disturbed sensory perception: Visual

Desired Outcomes:

Within 1 hour of nursing interventions, patient will remain free from harm resulting from visual disturbances.

Nursing Interventions
  • Assess patients knowledge of change in structure or function of the body part.
    • Rationale: The level of response is related to the perceived value or importance that the patient places on the affected body part.
  • Assist patient to identify actual changes
    • Rationale: Patients may perceive changes that are not actually present.
  • Encourage verbalization about concerns of the disease process and future expectations.
    • Rationale: This provides an opportunity to identify fears/misconceptions and deal with them directly.